Individual
KRISTIN KAY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
1217 PLAZA BLVD STE E, SUITE 130, CENTRAL POINT, OR 97502-2682
(541) 664-2800
(541) 664-0555
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4473
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0326284
WA L&I
WA
01
—
0326297
WA L&I
WA
05
—
182952
—
OR
01
—
P01582590
RR MEDICARE
OR
Enumeration date
11/28/2005
Last updated
02/23/2016
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